Ariel Blog Pancreatitis & Pain

Pancreatitis & Pain

Cameron Breze  |  Published August 3, 2020
Pancreatitis is a complex medical condition that manifests itself differently in each patient. While some patients experience no pain, the most common symptom of pancreatitis is pain in the upper abdomen [1], that may radiate to the back. This pain can range widely in severity and duration. Mild cases of pancreatitis may resolve on their own, but more severe cases require immediate medical intervention. If you are unsure about your symptoms, please seek medical help.

  Although some patients may experience a prolonged or severe course, most patients will return to feeling normal fairly quickly after an acute pancreatitis attack. In the hospital, replenishing lost bodily fluids is the first step to manage an episode of acute pancreatitis. To combat mild discomfort, a non-steroidal anti-inflammatory drug (NSAID) may be administered (i.e. aspirin). If pain persists, stronger pharmacological agents may be used, but this decision is made by the medical care team according to the patient’s specific situation [2].

  If these attacks recur, a patient may develop chronic pancreatitis. This diagnosis may be accompanied by intermittent or persistent, chronic abdominal pain. Chronic pain can have a severe impact on a person’s quality of life and daily activities. When managing pain in patients with chronic pancreatitis, a multi-pronged approach is used to address the complexity of the condition. Importantly, patients with chronic pancreatitis who present with a pain episode may no longer present with the classic elevated biomarkers of an acute pancreatitis attack s (i.e., amylase and lipase) due to destruction of pancreatic tissue, but they still require acute pain management for pancreatitis.

  Dietary and lifestyle changes may reduce pain in some individuals. Your doctor may recommend cessation of all alcohol consumption and smoking. These behaviors are risk factors for chronic pancreatitis and can accelerate the progression of the condition [3]. As the pancreas usually helps the body process food by secreting digestive enzymes, individuals with chronic pancreatitis may have issues with obtaining some essential nutrients they need. Your doctor may suggest decreasing the size and increasing the frequency of your meals (i.e. eating 6-8 small meals a day) to avoid overloading your pancreas [4]. Reducing the amount of fat in your diet may also reduce the workload on your pancreas and alleviate the steatorrhea, or oily stools, that may accompany pancreatitis. A multivitamin can also help to supplement essential micronutrients. If you are struggling to create a pancreatitis-friendly diet, please consult your doctor to be connected with a nutritionist, who can help you to design a plan. If indicated, pancreatic enzyme replacement therapy may also help alleviate symptoms, including pain.

  Even with all of these changes, a patient with chronic pancreatitis may be burdened with a significant level of pain. To alleviate these symptoms, your doctor may take a similar approach to the medical care team in the hospital. If your symptoms are mild, a simple NSAID may be appropriate for your condition. If non-opioids are unsuccessful, opioid medications may be prescribed [5]. Certain patient populations may be candidates for an endoscopic ultrasound celiac plexus block (EUS-CPB), a procedure that disrupts the transmission of pain signals in the spinal cord and central nervous system [6]. Patients with unrelenting pain may be eligible for surgical therapies to provide pain relief. Outside of bodily pain, an antidepressant may also be used to hedge against the mental toll of dealing with a complex condition like chronic pancreatitis [3].

  If you are tasked with managing chronic pancreatitis for yourself or someone you care about, the condition may feel overwhelming at times. It is important to know that you are not alone. Patient advocacy groups can help you connect with others living with the condition. Two of the most well-known are The National Pancreas Foundation and Mission:Cure. In addition to speaking to other patients about their condition, you may find it helpful to discuss how chronic pancreatitis places unique pressures on other areas of your life (i.e. work, relationships, etc.) and exchange strategies to live a full life, even after initial diagnosis. If you still feel down or have thoughts about harming yourself or others, please seek out immediate medical help.

  Resources

  1.  https://pancreasfoundation.org/patient-information/chronic-pancreatitis/causes-and-symptoms/
  2. https://www.pancreapedia.org/reviews/pain-management-in-acute-pancreatitis
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590150/
  4. https://health.clevelandclinic.org/best-and-worst-foods-for-pancreatitis-pain/
  5. https://pancreasfoundation.org/patient-information/chronic-pancreatitis/chronic-pancreatitis-pain-management-and-treatment/
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4423247/

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